Water-soluble vitamin deficiency and toxicity Quiz: Ace Your Exams

A 10-year-old boy is brought in by his parent to the clinic for evaluation of numbness in his feet and hands. He states that his hands and feet often have a tingling and burning sensation. He has had no abdominal pain, vomiting, constipation, or diarrhea. His past medical history includes latent pulmonary tuberculosis, for which he was started on isoniazid 3 months ago in India. His family recently immigrated from India in the past month, and the patient has continued taking his medication. His mother states he is doing well in school and is currently placed in advanced academic classes. Temperature is 37.0°C (98.6°F), pulse is 80/min, respirations are 20/min, and blood pressure is 115/65 mmHg. Neurological examination reveals symmetrical “glove and stocking” distribution peripheral neuropathy of the hands and feet, with diminished perception of touch and temperature. Motor strength is 5/5 in all four extremities, and deep tendon reflexes are 2+ in the upper and lower extremities. Which of the following could have prevented this patient’s current symptoms?